title: Maximizing the impact of antimicrobial stewardship: the role of diagnostics, national and international efforts.
abstract: OBJECTIVE
  The decline in the development and approval of new antimicrobial agents, especially those with activity against multidrug-resistant Gram-negative bacteria, has arisen as one of the major public health threats of the 21st century. Antimicrobial stewardship has emerged as a key available means to attenuate this threat. Because of the immediacy of the crisis imposed by the dearth of new antimicrobial agents, this review aims to seek out innovative mechanisms that could complement existing programmes to maximize their effectiveness.
  
  
  RESULTS
  Provision of expedited microbiological identification and susceptibility profiles utilizing molecular diagnostic techniques are means that are showing promise in complementing existing stewardship interventions. Biomarkers such as procalcitonin that facilitate clinical decision-making processes in discriminating between noninfectious causes masquerading as sepsis can assist in withholding or earlier discontinuation of antimicrobial agents. Seasonal influenza and polyvalent pneumococcal vaccine have a role to play by preventing secondary bacterial infections. Electronic learning tools are a means of disseminating information rapidly and universally. Coordinated national and international stewardship efforts play an essential role in promotion, engaging the public, and ensuring provision of sufficient resources.
  
  
  CONCLUSIONS
  The safeguarding of antimicrobial agents for future generations is necessary, if we as a public do not wish to face a world without antibiotics. All potentially available resources must be recruited to order to protect antimicrobials. Robust methods of evaluating each of these interventions needs to be included from inception to evaluate which strategies are the most effective.
authors.affiliation: Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, UK. deirdre.o'brien@nhs.net
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: O'Brien
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gould
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy*; D015415:Biomarkers / Q000032:analysis; D011307:Drug Prescriptions / Q000592:standards; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers